Acute rheumatic fever

Nonsuppurative complications such as acute rheumatic fever, acute glomerulonephritis, and reactive arthritis may occur as a result of pharyngitis with Group A Streptococcus. 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

E. The patient has exudative pharyngitis, presumably secondary to group A streptococcus. Antibiotic treatment is indicated to reduce the duration and severity of symptoms and to prevent acute rheumatic fever. The antibiotic of first choice is penicillin V. Other reasonable alternatives are benzathine penicillin G, erythromycin, cephalosporin, clindamycin, azithromycin, and clarithromycin. Amikacin, lome-fioxacin, metronidazole, and netilmicin are not active against group A streptococcus. 

Husby, G., van de Rijn, L, Zabriskie, J.B., Abdin, Z.H., and Williams, R.C., Jr. (1976) Antibodies reacting with cytoplasm of subthalamic and caudate nuclei neurons in chorea and acute rheumatic fever. / Exp Med 144 1094—1110. 

As antirheumatic Salicylates are the drug of choice in the treatment of rheumatoid arthritis. In larger dose they suppress the swelling, immobility and redness of the joints involved. They are also useful in the acute rheumatic fever. They produce relief in pain, swell-... 

Acute rheumatic fever is treated with anti-inflammatory agents such as aspirin. Corticosteroids are reserved for those patients with severe carditis who do not respond to or are unable to take salicylates. 

Dinkla K, Nitsche-Schmitz DP, Barroso V, Reissmann S, Johansson HM, Frick IM, Rohde M, Chhatwal GS. Identification of a streptococcal octapeptide motif involved in acute rheumatic fever. J Biol Chem. 2007 282(26) 18686-18693. Epub Apr 23. 

Dinkla K, Talay SR, Morgelin M, Graham RM, Rohde M, Nitsche-Schmitz DP, Chhatwal GS. Crucial role of the CB3-region of collagen IV in PARF-induced acute rheumatic fever. PLoS One. 2009 4(3) e4666. Epub Mar 2. 

Excessive production of IL-2 has been reported in pregnancy, multiple sclerosis, sarcoidosis, multiple myeloma, acute rheumatic fever, and chronic rheumatic heart disease... 

Narin N, Kutukculer N, Ozyurek R, et al. Lymphocyte subsets and plasma IL-1 a, IL-2, and TNF-a concentrations in acute rheumatic fever and chronic rheumatic heart disease. Clin Immuno Immunopathol 1995 77 172-6. 

Acute glomerulonephritis Acute rheumatic fever Bronchopneumonia [3]... 

May be abnormal if acute rheumatic fever occurs as complication... 

Acute rheumatic fever is seen rarely in developed countries. Acute rheumatic fever secondary to group A streptococcal infection was a cause of concern in the 1950s and was the major reason for penicillin therapy, but the incidence of this disease today is extremely rare (>1 in 1 million). However, the risk remains. Outbreaks have been reported in the United States as recently as the late 1980s and early 1990s. Furthermore, acute rheumatic fever is widespread in developing countries (e.g., it is estimated that there are 50,000 cases of acute rheumatic fever per year in India). 

The goals of treatment of pharyngitis are to improve clinical signs and symptoms, minimize adverse drug reactions, prevent transmission to close contacts, and prevent acute rheumatic fever and suppurative complications, such as peritonsillar abscess, cervical lymphadenitis, and mastoiditis. ... 

McDonald M, Currie B, Carapetis J Acute rheumatic fever a chink in the chain that links the heart to the throat Lancet Infect Dis 2004 4 240-245. 

Smoot JC, Barbian KD, Van Gompel JJ, Smoot LM, Chaussee MS, Sylva GL, Sturdevant DE, Ricklefs SM, Porcella SF, Parkins LD, Beres SB, Campbell DS, Smith TM, Zhang Q, Kapur V, Daly JA, Veasy LG, Musser JM Genome sequence and comparative microarray analysis of serotype Ml 8 group A Streptococcus strains associated with acute rheumatic fever outbreaks. Proc Natl Acad Sci USA 2002 99 4668 1673. 

Smoot LM, McCormick JK, Smoot JC, Hoe NP, Strickland I, Cole RL, Barbian KD, Earhart CA, Ohlendorf DH, Veasy LG, Hill HR, Leung DYM, Schlievert PM, Musser JM Characterization of two novel pyrogenic toxin superantigens made by an acute rheumatic fever clone of Streptococcus pyogenes associated with multiple disease outbreaks. Infect Immun 2002 70 7095-7104. 

Rheumatic valvular heart disease/acute rheumatic fever... 

American Registry of Diagnostic Medical Sonographers adult respiratory distress syndrome acute renal failure acute rheumatic fever acute respiratory failure... 

Aspirin reduces the leukocytosis associated with acute rheumatic fever. When given on a long-term basis, it also reduces the hanoglobin level and the hematocrit. Aspirin use can cause reversible hypoprothrombinemia by interfering... 

See footnotes in Table 6.5 for the definition of clinical result classifications for acute rheumatic fever, rheumatoid arthritis, and cervical spine-shoulder and lumbar spine syndromes. 

Prior to 1997, erythromycin was an alternative antibiotic choice to amoxicillin for prophylaxis prior to dental, oral, esophageal, and respiratory procedures to prevent infective endocarditis (IE). Erythromycin is an alternative choice for treating a recurrence of acute rheumatic fever in patients allergic to penicillin [12]. Recently updated recommendations by the American Heart Association for IE... 

Pharyngitis is the most common disease produced by S. pyogenes. Penicillin-resistant isolates of this organism have yet to be observed. The preferred oral therapy is with penicillin V, 500 mg every 6 hours for 10 days. Equal results are produced by the administration of 600,000 units of penicillin G procaine intramuscularly once daily for 10 days or by a single injection of 1.2 million units of penicillin G benzathine. Parenteral therapy is preferred if there are questions of patient compliance. Penicillin therapy of streptococcal pharyngitis reduces the risk of subsequent acute rheumatic fever but not of poststreptococcal glomerulonephritis. 

The oral administration of 200,000 units of penicillin G or penicillin V every 12 hours markedly decreases the incidence of recurrences of rheumatic fever in susceptible individuals. Intramuscular injection of 1.2 million units of penicillin G benzathine once monthly also yields excellent results. Because acute rheumatic fever has been observed in the fifth decade, some advocate that prophylaxis should be continued for life. 

It is generally used for the reduction of fever and the relief of pain. It also possesses anti-inflammatory actions similar to aspirin. It is recommended in acute rheumatic fever and in the symptomatic therapy of gout. 

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